Recurrent BRAF Gene Rearrangements in Myxoinflammatory Fibroblastic Sarcomas, but Not Hemosiderotic Fibrolipomatous Tumors

Am J Surg Pathol. 2017 Nov;41(11):1456-1465. doi: 10.1097/PAS.0000000000000899.

Abstract

Myxoinflammatory fibroblastic sarcoma (MIFS) is a low grade soft tissue sarcoma with a predilection for acral sites, being associated with a high rate of local recurrence but very infrequent distant metastases. Although a t(1;10) translocation resulting in TGFBR3-MGEA5 fusion has been reported as a recurrent genetic event in MIFS, this abnormality is seen only in a subset of cases. As no studies to date have investigated the spectrum of alternative genetic alterations in TGFBR3-MGEA5 fusion negative MIFS, we undertook a genetic analysis of this particular cohort for further molecular classification. Triggered by an index case occurring in the finger of a 37-year-old female and harboring a novel TOM1L2-BRAF fusion by targeted RNA sequencing we investigated potential recurrent BRAF abnormalities by screening a large group of 19 TGFBR3-MGEA5 fusion negative MIFS by fluorescence in situ hybridization. There were 6 (32%) additional MIFS with BRAF genetic abnormalities, including 5 gene rearrangements and one showing BRAF amplification. Interestingly, VGLL3 amplification, a recurrent genetic abnormality coexisting with t(1;10) in some MIFS, was also detected by fluorescence in situ hybridization in 4/6 (67%) BRAF-rearranged MIFS, but not in the BRAF-amplified case. Up-regulated VGLL3 mRNA expression was also demonstrated in the index case by RNA sequencing. The 7 BRAF-rearranged/amplified MIFS arose in the fingers (n=3), and 1 each in wrist, forearm, foot, and knee, of adult patients (36 to 74 y; M:F=4:3). The histologic spectrum ranged from predominantly solid growth of plump histiocytoid to epithelioid tumor cells with focal myxoid change to a predominantly myxoid background with scattered tumor cells. Varying degree of inflammatory infiltrates and large tumor cells with virocyte-like macronucleoli were observed in most cases. Immunohistochemical stains of phosphorylated ERK, a downstream effector of BRAF activation, were positive in all 4 cases tested (2 diffuse strong, 2 focal strong). Unlike t(1;10), BRAF rearrangements were only found in MIFS but not in 6 hemosiderotic fibrolipomatous tumor (HFLT) lacking TGFBR3-MGEA5 fusions (including 2 pure HFLT, 2 hybrid HFLT-MIFS, and 2 associated with pleomorphic hyalinizing angiectatic tumors).

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Antigens, Neoplasm / genetics
  • Biomarkers, Tumor / analysis
  • Biomarkers, Tumor / genetics*
  • Carrier Proteins / genetics
  • Case-Control Studies
  • Extracellular Signal-Regulated MAP Kinases / analysis
  • Female
  • Fibrosarcoma / enzymology
  • Fibrosarcoma / genetics*
  • Fibrosarcoma / pathology
  • Gene Amplification
  • Gene Fusion
  • Gene Rearrangement*
  • Genetic Predisposition to Disease
  • Hemosiderosis / enzymology
  • Hemosiderosis / genetics*
  • Hemosiderosis / pathology
  • Histone Acetyltransferases / genetics
  • Humans
  • Hyaluronoglucosaminidase / genetics
  • Immunohistochemistry
  • In Situ Hybridization, Fluorescence
  • Lipoma / enzymology
  • Lipoma / genetics*
  • Lipoma / pathology
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Phenotype
  • Phosphorylation
  • Proteoglycans / genetics
  • Proto-Oncogene Proteins B-raf / genetics*
  • RNA, Messenger / genetics
  • Receptors, Transforming Growth Factor beta / genetics
  • Reverse Transcriptase Polymerase Chain Reaction
  • Sequence Analysis, RNA
  • Soft Tissue Neoplasms / enzymology
  • Soft Tissue Neoplasms / genetics*
  • Soft Tissue Neoplasms / pathology
  • Transcription Factors / genetics

Substances

  • Antigens, Neoplasm
  • Biomarkers, Tumor
  • Carrier Proteins
  • Proteoglycans
  • RNA, Messenger
  • Receptors, Transforming Growth Factor beta
  • TOM1L2 protein, human
  • Transcription Factors
  • VGLL3 protein, human
  • betaglycan
  • Histone Acetyltransferases
  • BRAF protein, human
  • Proto-Oncogene Proteins B-raf
  • Extracellular Signal-Regulated MAP Kinases
  • OGA protein, human
  • Hyaluronoglucosaminidase